Category Archives: Gorski

03/23/15

Stinkin’ Thinkin’ Addiction

© Gennadiy Kravchenko | 123RF.com

© Gennadiy Kravchenko | 123RF.com

“Most Substance-addicted people are also addicted to thinking, meaning they have a compulsive and unhealthy relationship with their own thinking.” (David Foster Wallace, Infinite Jest)

Once a person becomes dependent upon a drug there is a tendency to transfer that addiction to other mood-altering substances. This is what is meant by cross addiction. If an individual becomes addicted to one drug, they can rapidly develop an addiction to another drug in that class of drugs. The reason is mostly physical. The body becomes accustomed to the effects of one kind of drug and will have an affinity to drugs that are similar. “Cross addiction occurs because all addictions work in the same part of the brain.” For an in-depth examination of the neurobiological factors underlying drug addiction and relapse, read “Neuroplasticity in Drug Addiction” on “Terry Gorski’s Blog.”

A chemically dependent person who comes to rely on a particular drug may, for various reasons, decide to abstain from that drug. If they substitute something else, it may not be as effective as the original drug of choice was for them. This can lead to thinking about or craving the original drug. Intoxication with the substitute drug that results in impaired thinking could lead them to use their primary drug again. You don’t have to be incredibly intoxicated either. You just have to be high enough to want your drug of choice and be willing to act on the impulse.

Alisha celebrated a years worth of clean time since she stopped using cocaine. She went out to dinner with a guy on a first date. He must have wanted to impress her, because he’d taken her to a very nice restaurant. He didn’t know about her history and ordered a bottle of wine. Alisha didn’t see the harm in having a glass or two of wine; alcohol had never been her thing. In the middle of the dinner she excused herself and called her cocaine dealer from the bathroom.

In The Science of Addiction, Carleton Erickson said that cross-dependence or cross-tolerance occurs between drugs within the same class. So when a person becomes dependent upon one benzodiazepine, they are dependent upon other benzodiazepines. “It is also possible for a person to be cross-tolerant to drugs of different classes.” One example could be benzodiazepines and alcohol.

Cross-dependence between classes occurs as well. “Reports suggest that such cross-dependence occurs between alcohol and cocaine, alcohol and nicotine, alcohol and benzodiazepines, and heroin and cocaine.” Terence Gorski suggested that this cross-dependency is likely to develop gradually. Early in my professional career I referred a heroin addict to an inpatient detox and rehab program, expecting that the individual would be referred back once the inpatient treatment was completed. In their infinite wisdom, the treatment staff referred the man to a methadone clinic. Two or three years later, he came back to my outpatient program, but not for heroin. He never resumed using heroin. Now he had a serious alcohol problem. What started out as a few drinks to take the edge off became a full-blown alcohol dependency problem.

Substance use disorders cannot be effectively treated as if each one is a discrete disease entity. Stable, long term sobriety is only possible if the person lays a foundation of abstinence from all addictive drugs and then works through the personal and social dysfunction that inhabited their life concurrently with their substance use. Sobriety is not simply whether or not you are drinking or using drugs. A relapse begins sometime before the individual resumes active drinking or drug use. Terence Gorski has said:

Sobriety is abstinence from addictive drugs plus abstinence from compulsive behaviors plus improvements in bio-psycho-social health. Sobriety includes all three things. To the extent that you have accomplished those three things you are sober; to the extent that you have not accomplished those three things you are not sober.

The grey area between initial abstinence and sobriety is where cross-addictions develop. These substitutes can be other chemicals or compulsive behaviors—what Gorski referred to as “process addictions.” These compulsive behaviors/process addictions will typically fall into eight types: 1) eating/dieting; 2) gambling; 3) working/achieving; 4) exercising; 5) sex; 6) thrill seeking; 7) escape; 8) spending.

Compulsive behaviors are actions that can produce excitement or emotional release, what Gorski called an addictive brain response. “This means that the brain is flooded with pleasure chemicals that create a unique sense of euphoria while being inhibiting from producing warning chemicals which cause the feelings of stress, anxiety, fear, and panic.” So these triggers initiate a neurochemical reaction that reinforces the person to keep pulling the addictive trigger.

Evidence supportive of this view is found in the treatment of pathological gambling with the opiate antagonist, naltrexone (here). Piz et al. published a case report where a patient with a compulsive gambling problem avoided a resumption of gambling for three years while taking naltrexone.

Many people begin with a chemical addiction and in sobriety “crossover” or “migrate” into a process addiction. In his book, Staying Sober, Terence Gorski noted how the same behaviors could be compulsive, process addictions or positive outlets. “Every behavior that can be used compulsively, can be productive if used in a way that does not result in long-term pain or dysfunction.” A behavior that is used compulsively is used as some people use drugs—to alter mood, turn off mind and evade reality. Behaviors are positive outlets when they enhance reality and help a person to cope more effectively with reality.

I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of articles based upon the material available on his blog and website.

03/2/15

Pulling the Addiction Trigger

© Imageegami | Dreamstime.com

© Imageegami | Dreamstime.com

When you pull the addiction trigger, the disease of addiction fires off addictive thinking, automatic addictive or drug seeking behavior, and a craving or urge that pulls you toward high risk situations. (Terence Gorski)

The term “trigger event” is used to describe what turns on the addictive thinking, drug seeking behavior, or the craving (a strong need or drive) to be involved in high risk situations (See “The Yin-Yang of High Risk Situations”). Using the metaphor of a loaded gun, Gorski said addiction in early recovery is very much like holding a loaded gun—with a hair trigger.

The problem is that events and circumstances act as powerful triggers for some people, while they have no effect on others. What can be even more confusing is that some days a circumstance can activate a powerful trigger. But on other days the same situation does nothing to pull the trigger and activate the craving.

Mistakenly, triggers are often seen as only external to the person. So the focus in managing triggers becomes one of identifying and avoiding external situations related to drug use and drinking. But triggers can be internal as well as external. Gorski defined a trigger event as “any internal or external occurrence that activates a craving (obsession, compulsion, physical craving, and drug-seeking behavior).” By internal occurrences he means thoughts or feelings. External occurrences involve the five senses: sight, sound, smell, taste and touch.

For these events to become triggers, they have to be connected to the person’s use of alcohol or drugs. The trigger is stronger if the event happened just before or while using. This is what makes needles, when drawing blood, a trigger to the IV drug user. Years ago I knew someone who couldn’t listen to “The Wall” by Pink Floyd in early recovery because he always did so before when he was high.

Gorski then said there were three phases in “disempowering” a trigger. Phase 1 was Avoidance. Here the person is to make a list of the most powerful triggers associated with his using and avoided them. The ubiquitous recovery mantra to avoid people, places and things (PPT) associated with addiction fits here.

The second phase was to gradually re-introduce some “trigger” events, along with good recovery support. This would not include returning to a bar where you used to drink. But it could mean going to a restaurant or party where alcohol will be served. There could be a local bar and grill that is known for its wings. Going there in early recovery is not a good idea, but with support later on might be acceptable. Maybe try getting takeout a few times first.

Alcohol is such a part of our society, total avoidance would mean a very sheltered and limited life. “Therefore, in order to lead any kind of normal life, gradual introduction is necessary.” There is an Italian restaurant, with an attached sports bar near a local N.A. meeting. After the meeting, some members go there for pizza; others don’t. This gradual re-introduction is just that—GRADUAL. And it shouldn’t be practiced when the person’s sobriety is unstable. Stress or instability in sobriety means that phase 1 avoidance should be instituted.

The third phase is extinction, meaning that the using trigger’s ability to activate a craving is eliminated or extinguished. A woman habitually sat in one particular barstool at home when she drank. In early recovery she learned to avoid sitting there, because it activated her “stinking thinking.” Through repeated times of sitting in the barstool when doing other things like drinking her morning coffee and reading a book, paying her bills, etc. she extinguished sitting in the barstool as a trigger event of her cravings to drink.

This is a process of retraining your mind or desensitizing it to what used to be stimuli (triggers) to get high. You may recognize the principles of operant and even classical conditioning incorporated within Gorski’s process of disempowering triggers.  But these principles alone aren’t always enough to bring about successful extinction of a trigger. The above comments drawn from Gorski’s article suggested this—when the sporadic nature of some triggers was mentioned. “Without a clear understanding of the psychobiological dynamics of a trigger event, the only way to learn to [manage] them is through trial and error.” Why is this?

I’d suggest that humans are psychosomatic unities of body (soma) and soul (psyche). See another article, “We Are But Thinking Reeds,” for greater discussion of this concept. Existing within the soul are not only the internal events of thoughts and feelings, but deeper desires, wants and loves. In recovery you see this expressed by the phrase “I want what I want.” The ‘psychobiological dynamics’ of a trigger event engages these desires as well as the thoughts and feelings.

Disempowering triggers can extinguish the reinforcement pattern of the thoughts and feelings to the external event, but they cannot eradicate the deep desires. One of these desires is the “loaded gun” of wanting to get high. Here is where self-control in recovery comes in—learning to not act on the thoughts and feelings that stem from it; not giving into the desire to get high. At best, this desire will go into hibernation. Practicing a program of recovery will help keep it there.

I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of articles based upon the material available on his blog and website.

01/19/15

The Yin-Yang of High Risk Situations

Jin and yang mask by sognolucido

Jin and yang mask by sognolucido

We’d discussed a plan to keep Andrea as safe as possible. Her brother had urged her to come to the family Christmas celebration and she didn’t feel she could say no. Many of her family members were drinkers, but she was going with her fiancée and neither one of them would be drinking. Most family members knew she’d just got out of rehab at the beginning of December and were supportive of her abstinence. Her brother had vowed to tell their heavily drinking uncle to keep his distance from her. She also wanted to show her family what the sober Andrea looked and acted like. Last Christmas has been a disaster.

She had talked ahead of time to her sponsor about going and agreed to call her at least once during the celebration and after she had returned home. She arranged with Chad, her boyfriend, and Matt, her brother to approach them and say she had to leave if she felt triggered by anything. Andrea and Matt rode together to the party, so they could leave whenever they needed. Her sponsor had also told her about a late night meeting she could get to as well. The party was great. She wasn’t triggered. Even Uncle Al seemed to have been more sober than usual.

A few days later, she had a phone call from a friend’s mother telling her that the woman’s niece had overdosed the night before. Andrea had known the woman, and even talked to her when they met at the grocery store, just after Andrea had got out of rehab. Although she was freaking out on the inside, she felt she had to listen to the friend’s mother and try to comfort her. Andrea still felt guilty that she had introduced the woman’s daughter to heroin. The first anniversary of the girl’s death from a car crash had come while Andrea was in treatment.

When Andrea got off the phone fifteen minutes later, she was shaking. She didn’t want to call her sponsor again; they’d talked earlier in the day and she knew her sponsor was going to be at a family dinner. She told Chad what had happened and said she was going to take a walk to clear her head—alone. Down the block, she decided to walk to the convenience store for a pack of cigarettes; she was almost out. Standing in line with her back to the front door and replaying the conversation with the friend’s mother in her head, she didn’t see a drug dealer she knew until he tapped her on the shoulder and called her name.

Andrea was in two situations that could be dangerous to her recovery. The first was one of her choosing; the second she didn’t see coming. Nevertheless, they both fit what Terence Gorski would describe as a High Risk Situation (HRS). Gorski said that a high risk situation is: 1) any experience that causes you to either move away from support for your recovery; or 2) leads to you going around people, places and things that would support your return to addictive use. He then specified this yin-yang of people, places and things and addiction further by giving a list of ten criteria:

To be more specific, a high risk situation can be described as any experience that meets one or more of the following criteria. The more criteria that are part of the experience, the higher the risk of starting addictive use.

Andrea’s first situation, going to the family Christmas party, would have met numbers 2, 3 and 4 on Gorski’s list. She was around people who would support her return to drinking (Possibly Uncle Al, maybe others who didn’t understand why she couldn’t just one drink to celebrate). She had easy access to alcohol. She was around other people who were acting out on their addiction (at least Uncle Al). But she had a plan to minimize the high risk criteria.

As Gorski noted in his article, having a plan to extract yourself from a high risk situation and then getting in contact people supportive of your abstinence can help you get away from it without using. Andrea went with her fiancée, who also wasn’t drinking. Her brother and others at the party knew she was abstinent and were supportive of her recovery. She had a plan to get to a meeting if indeed she did start to have thoughts or cravings to use. She told others of her planned emergency exit strategy. She went into a high risk situation with a plan and got out without using.

The second situation is less obviously a high risk situation because of the chance encounter Andrea had with the drug dealer. Does this mean she can never be out alone? Gorski said that in relapse prevention there are “Apparently Irrelevant Decisions that put people in high risk situation that seem to happen by chance.” In Andrea’s case, she felt she needed to try and comfort her friend’s mother even though she was freaking out inside. She should have ended the conversation or had Chad try and console the woman. She also chose not to call her sponsor—even though it made sense not to do so at the time. She went out alone and then decided to go for cigarettes—again alone—while she was still upset by her phone call.

These seeming irrelevant decisions on her part led to Andrea being alone while she was around a person who would support her drug use and even supply what she needed to get high. All the while she was still struggling to control strong feelings and emotions from her phone conversation. She also had limited options available to cope with or get out of the situation. The scenario doesn’t say what she did, but even before we speculate how she could respond, Andrea has met five of Gorski’s ten criteria. And remember, the more criteria that are part of the experience, the higher the risk of using.

Andrea are her situations are fictional, but the various pieces of each of them have really happened to people I’ve known in early recovery. Sometimes it can almost feel like an improbable scene scripted in a bad Hollywood movie. So how does Andrea keep herself prepared for the unexpected high risk situation? Simply reverse Gorski’s two yin-yang criteria—move away from people, places and things that support your return to addictive use; and put yourself around the people, places and things that support your recovery. Apply it to Andrea’s situation and see what you think she should do.

I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of articles based upon the material available on his blog and website.

09/1/14

There is Nothing New Under the Sun

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Impression from a Sumerian cylinder seal from 2600 BC. Persons drinking beer are depicted in the upper row.

I have never used any mind altering drug that was not pharmaceutical grade. People who put drugs of unknown composition and purity in their bodies are either ignorant (they don’t know the real risks to the brain and mind), stupid (they know the risk and choose to ignore it), or addicted (they know the risk, want to stop, but find that they can’t). ~ Timothy Leary, in a private conversation with Terence T. Gorski.

Terence Gorski posted this quote at the end of a brief essay, “Poison as a Preferred Pleasure.” He first expressed his amazement with how many people today view alcohol and marijuana as harmless. Even more frightening to him was the willingness of people to experiment with new, largely unknown substances in the pursuit of getting high. See my essay on Playing Chemical Whack-a-Mole.

From the earliest times of culture and civilization, humans have pursued intoxication. According to Ronald Siegal, “Throughout our entire history as a species, intoxication has functioned like the basic drives of hunger, thirst and sex. . . . It is as bold and inescapable as the drug stories that dominate today’s headlines.”

The first mention of drunkenness in the Bible is when Noah became intoxicated after he planted a vineyard and ate some of the grapes. He gets naked, passes out and is seen by one of his sons, Ham. But I’m intrigued by the commentary on this story within a Hebrew midrash, Midrash Tanuma. There, the story is that Noah and Satan entered into a business arrangement to plant a vineyard. It was through this partnership, that Noah learned about the intoxicating qualities of wine. Satan’s contribution was to slaughter a lamb, a lion, a pig and a monkey and fertilize the vineyard’s soil with each in turn. What Noah learned from this was:

If a man drinks one glass, he is as meek as a lamb; if he drinks two glasses, he is boastful and feels as strong as a lion; if he drinks three or four glasses, then behaves like a monkey, he dances around, sings, talks obscenely and does not know what he is doing; and if he becomes intoxicated he resembles the pig.

The process of fermenting beverages like wine and beer runs parallel with the transition of humanity from hunter-gatherers into farmers, and eventually to cities and civilization. Beer was most likely a staple of human diets before wine was. It has even been argued that the discovery of the intoxicating effects of beer was a motivating factor for our hunting-gathering ancestors to settle down and become farmers.

2954474f708cf44b07237af4d40e46e7By the time that writing was invented, beer was no longer just an agricultural product of the rural villages. It was one of the surplus products important to the centralized economy of Sumerian city-states. The discovery of administrative cuneiform documents of the production and consumption of beer illustrates the important economic role beer played in Sumerian culture. The earliest known written documents are Sumerian wage lists and tax receipts which contain the symbol for beer, one of the most common words in the documents.

cuneiform tablet depicting beer allocation, c. 3000 b.c. British Museum Photograph: takomabibelot on Flickr

cuneiform tablet depicting beer allocation, c. 3000 b.c. British Museum Photograph: takomabibelot on Flickr

From the beginning, beer had an important social aspect. Sumerian depictions from the third millennium BCE (like that above) show two people drinking through straws from a shared vessel. The technology to filter out the grain, chaff and debris from beer had been developed, but the continued use of straws suggested this was a ritual that persisted even after straws were no longer needed. Perhaps sharing a drink was a symbol of hospitality and friendship. “It signals that the person offering the drink can be trusted, by demonstrating that it is not poisoned or otherwise unsuitable for consumption.”

Beer had a religious role in Sumerian culture as well. The Hymn to Nakasi was simultaneously a song of worship to the goddess of beer and a recipe for brewing beer! See section 6.1 of the article on Sumerian Beer for the text of the hymn. Nevertheless, Sumerian beer was likely consumed in taverns, similar to medieval times. At the end of the hymn, the goddess Nakasi pours out beer for the drinkers, giving her the role of both brewer and tavern-keeper.  Women were typically the ones who brewed and sold beer in ancient Mesopotamia.

The Egyptians also excelled in the arts of fermenting wine and brewing beer. Not only were such intoxicants for the living, they were said to be used by the dead in the afterlife. Menquet, the Egyptian goddess of beer, was pictured as a woman holding two jars of beer. Hathor, represented as a sacred bull, was the god of wine. He was duly honored on a monthly “Day of Intoxication.”

The Preacher in Ecclesiastes can help put the latest intoxicant fad with synthetic drugs or new psychoactive substances into perspective: There is nothing new under the sun. From the time human beings first settled down into villages, they have looked for new and better ways of getting high.

What has been is what will be, and what has been done is what will be done, and there is nothing new under the sun. Is there a thing of which it is said, “See, this is new”? It has been already in the ages before us. There is no remembrance of former things, nor will there be any remembrance of later things yet to be among those who come after. (Ecclesiastes 1:9-11)

I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of blog posts based upon the material available on his blog and website.

 

 

 

 

 

08/11/14

Déjà Vu All Over Again

Leo (not his real name) walked into our outpatient clinic with a daypack over his right shoulder smelling strongly of booze. He would later show us the half-empty bottle of vodka he carried inside of it. Three of the treatment staff did an impromptu “intervention” and at one point he almost gave us the bottle. Sadly the vodka was more alluring to him at the time. He kept the bottle.

We knew and liked Leo. He had been in our partial treatment program at least 2 or 3 times before. He demonstrated personal change; helped others with their own drug and alcohol use problems; and usually completed the treatment program. But he repeatedly lapsed or relapsed into active drinking.

He wasn’t angry or belligerent. He didn’t even get upset when we told him if he walked out of the office we would call the local police. He just quietly got up and left—with his daypack. I followed him outside and watched him walk away. The last time I saw him that day he was fifty yards away; slinging his daypack off of his back as he disappeared behind some trees.

Sarah (not her real name) had completed her third or fourth outpatient treatment few months after she turned twenty. This time she had a very good sponsor; had several other women with solid recovery in her sober support system; and seemed to really be trying to remain abstinent. Then we heard that she had announced to everyone that she intended to celebrate her 21st birthday with a pub-crawl. Several people tried to talk her out of this crazy idea, but she wasn’t budging.

I got permission to hold a birthday party for her at the aftercare group I oversee. And then I invited Sarah and anyone in her sober support system that wanted to come. We had a quarter-sized sheet cake and ice cream. Sarah didn’t come, but I saved her a piece of cake and put it in my freezer. About a month later on her birthday, she went on a pub-crawl with her friend. The friend ended up in the hospital with alcohol poisoning. Sarah kept drinking and using drugs for another six or seven months.

When she came back to the Aftercare group, I told her I had a piece of birthday cake for her in my freezer.  When she achieved one year of abstinence, I’d give her the birthday cake. She returned after her one-year anniversary and I gave her the piece of cake. I haven’t heard from her for a few years, but the last news I had was that she was still sober.

Relapse into active drug or alcohol use is, sadly, a common occurrence in recovery. But it doesn’t always have to be. Like the new Tom Cruise science fiction movie, “Edge of Tomorrow,” persistence and repeated battle against addiction can be an opportunity to eventually overcoming this personalized alien invader. But if it’s addiction and not the Mimics that you battle, I suggest you trust in Terence Gorski and not Tom Cruise for your deliverance.

Among the many tools developed by Gorski for this battle is the AWARE (Advance WArning of RElapse) Questionnaire.  It was designed and refined as a measure of the warning signs of relapse. It is simple to use and interpret: the higher the score, the greater the number of relapse warning signs being reported. It was developed through research funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). So it is in the public domain and may be used without specific permission; so long as the proper recognition is given as to its source.  You can read Gorski’s original blog post on the AWARE Questionnaire. And you can download a printer-friendly version of it that I’ve put together here.

I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of blog posts based upon the material available on his blog and website.

07/7/14

Never Give Up Hope

Adam’s lead was one of those powerful tales of riches-to-rags-to-riches of drinking and drug use leading to a “low bottom” and then recovery. His bottom included being homeless; losing his job; jail; the whole works. And then he got sober. He always concluded by saying: “And I know that if I ever were to pick up again, I’m never coming back.” He meant what he said. His audience believed him. And when he did pick up, he never came back.

When I was an intern at an outpatient drug and alcohol clinic, I heard the tale of Adam’s relapse. That wasn’t his real name; I don’t think I ever knew it. But Adam’s story was my first lesson in mistaken beliefs about relapse: His mistaken belief about relapse created a self-fulfilling prophecy.

In his booklet Mistaken Beliefs About Relapse, Terence Gorski said: “A mistaken belief is something that you believe to be true and act as if it were true when, in fact, it is false.” Within it, he listed seventeen separate mistaken beliefs. Adam seems to have believed numbers 16 and 17.

Number 16: “Once you begin using it is impossible for you to interrupt your relapse before you have ‘hit bottom’ again.” Many addicts program themselves for a destructive relapse. They believe that it is better to be dead than drunk or high. This seems to be what Adam had buried in the concluding statement to his lead. Once he started, he believed there was no way he could stop. His first bottom was so low, that next was death.

It is true that once you again begin to use addictively, you can never be sure of what is going to happen. But you can have periodic moments of sanity; times where you “regain control of your thinking, your emotions, your memory and your behavior and judgment. . . . It is your responsibility to yourself and those whom you love to get help to interrupt the relapse during these moments of sanity.”

Number 17: “Successful recovery from addiction requires continuous abstinence from the time of the initial commitment to sobriety.” It is a fact that most addicts and alcoholics are not able to maintain permanent abstinence the first time they try. But this is NOT MEANT to be permission to periodically drink or use. There is a difference between a lapse—the initial return to addictive use, and a relapse—the destructive return to loss of control, addictive use.

There are two choices. The person can get help from others to return to abstinence (call your sponsor or others people in your support system; get back into treatment). Then they need to learn from the experience what went wrong; and what they need to do to stay sober in the future. Or they can convince themselves that staying sober is hopeless and continue to use destructively. “If they believe they are hopeless or that they have failed totally because they have lapsed, they will give up and not continue in their efforts to recover.” Sometimes they are lucky enough to have the right set of circumstances re-engage them in treatment or other help. Sometimes they die in their addiction like Adam.

In his blog post on Mistaken Beliefs About Relapse, Gorski discussed what he called the three most common mistaken beliefs about relapse: 1) that it is self-inflicted; 2) that it is an indication of treatment failure; and 3) once relapse occurs the person will never recover. These mistaken beliefs are differently worded than those in his booklet, Mistaken Beliefs About Relapse, but still worth reading and thinking about in their own right.  Adam seems to have fallen prey to the third one.

There are two additional mistaken beliefs I hear a lot: First, that relapse is a part of recovery. Relapse is often a part of someone’s recovery journey, but it doesn’t have to be. Second, some people are “constitutionally incapable” of recovery. Here, Gorski said it best: “The consequence of believing you cannot get well is despair. Without hope there is no motivation to try again and you are condemned to a life of despair.” Never say never. And never give up hope.

What other mistaken beliefs about relapse or recovery have you encountered? 

I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of blog posts based upon the material available on his blog and website.